Methotrexate in Combination With Infliximab Is No More Effective Than Infliximab Alone in Patients With Crohn's Disease

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 146; no. 3; pp. 681 - 688.e1
• Main Authors: Feagan, Brian G., McDonald, John W.D., Panaccione, Remo, Enns, Robert A., Bernstein, Charles N., Ponich, Terry P., Bourdages, Raymond, MacIntosh, Donald G., Dallaire, Chrystian, Cohen, Albert, Fedorak, Richard N., Paré, Pierre, Bitton, Alain, Saibil, Fred, Anderson, Frank, Donner, Allan, Wong, Cindy J., Zou, Guangyong, Vandervoort, Margaret K., Hopkins, Marybeth, Greenberg, Gordon R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2014
• Subjects: Adult; Antibodies, Monoclonal - therapeutic use; C-Reactive Protein - metabolism; COMMIT; Crohn Disease - blood; Crohn Disease - drug therapy; Double-Blind Method; Drug Therapy, Combination; Female; Gastroenterology and Hepatology; Humans; IBD; Inflammatory Bowel Disease; Infliximab; Kaplan-Meier Estimate; Male; Methotrexate - therapeutic use; Middle Aged; Prednisone - therapeutic use; Randomized Controlled Trial; Treatment Outcome; CRP; CD; COMMIT; CBC; CDAI; CI; IBD; Inflammatory Bowel Disease; Randomized Controlled Trial; SF-36; C-reactive protein; Crohn's disease; Crohn's Disease Activity Index; complete blood count; confidence interval; Short-Form 36
• ISSN: 0016-5085; 1528-0012; 1528-0012
• DOI: 10.1053/j.gastro.2013.11.024

Methotrexate and infliximab are effective therapies for Crohn's disease (CD). In the combination of maintenance methotrexate-infliximab trial, we evaluated the potential superiority of combination therapy over infliximab alone. In a 50-week, double-blind, placebo-controlled trial, we compared methotrexate and infliximab with infliximab alone in 126 patients with CD who had initiated prednisone induction therapy (15–40 mg/day) within the preceding 6 weeks. Patients were assigned randomly to groups given methotrexate at an initial weekly dose of 10 mg, escalating to 25 mg/week (n = 63), or placebo (n = 63). Both groups received infliximab (5 mg/kg of body weight) at weeks 1, 3, 7, and 14, and every 8 weeks thereafter. Prednisone was tapered, beginning at week 1, and discontinued no later than week 14. The primary outcome was time to treatment failure, defined as a lack of prednisone-free remission (CD Activity Index, <150) at week 14 or failure to maintain remission through week 50. Patients' baseline characteristics were similar between groups. By week 50, the actuarial rate of treatment failure was 30.6% in the combination therapy group compared with 29.8% in the infliximab monotherapy group (P = .63; hazard ratio, 1.16; 95% confidence interval, 0.62–2.17). Prespecified subgroup analyses failed to show a benefit in patients with short disease duration or an increased level of C-reactive protein. No clinically meaningful differences were observed in secondary outcomes. Combination therapy was well tolerated. The combination of infliximab and methotrexate, although safe, was no more effective than infliximab alone in patients with CD receiving treatment with prednisone. ClincialTrials.gov number, NCT00132899.